The document discusses Herpes Zoster (shingles), caused by the varicella zoster virus which causes chickenpox. After initial chickenpox infection, the virus can lay dormant in nerve fibers and reactivate as shingles, presenting as a painful rash localized to specific dermatomes. The rash involves clusters of vesicles in a band-like distribution along dermatomes. Treatment involves antiviral drugs to reduce symptoms and analgesics to manage pain. Nursing care focuses on preventing secondary infection, managing pain and promoting comfort during the infection period.

1. Prepared by:
Rozelle Mae E. Birador
HERPES ZOSTER
( Shingles/ Acute Posterior
Ganglionitis)

2. Definition
 Commonly known as “ Shingles”
 After initial exposure, Herpes Zoster lies foemant
in certain nerve fibers.
 It may become active as a result of many factors
such as aging, stress, suppression of the immune
system, and certain medications.

3. Etiologic Agent
 Varicella- zoster (V-Z) virus
 Same virus responsible for chickenpox (varicella)
 The virus occurs in partially immune individuals
due to previous varicella infection.

4. Incubation Period
 Unknown
 But believed to be 13 to 17 days

5. Period of Communicability
 Herpes zoster is communicable a day before the
appearance of the first rash until five to six days
after the last crust disappears.

6. Mode of Transmission
 Herpes zoster can be transmitted through direct
contact, specifically, through droplet infection
and airborne spread.
 It can also be transmitted through indirect
contact, e.g., articles freshly soiled by secretions
and discharges from an infected person.

7. Pathogenesis
 The varicella zoster virus may persist in a
dormant state in the dorsal nerve root ganglia.
 The virus may later emerge from the site, either
spontaneously or in association with
immunosuppression, to cause herpes zoster.
 It produces localized vesicular skin lesions
confined to a dermatome and severe neurologic
pain in the peripheral areas innervated by the
nerves arising in the inflamed root ganglia.
 This infection usually occurs in adults.

8. Herpes Zoster in a thoracic
dermatome

9. Clinical Manifestations
Any part of the trunk may be affected, but the
thoracic segment is commonly involved. Other
areas that may be affected are the extremities
and branches of the 5th and 7th cranial nerves.
The virus affects the ganglion of the posterior
nerve roots or the extramedullary cranial nerve
ganglion.

10. Clinical Manifestations
1. The erythematous base of the skin lesion
appears first. It is followed by the appearance of
the vesicles within 24 hours. A cluster of
vesicles appears to form patches, which
coalesce to form an irregular, band-like
distribution along the course of involved
dermatomes. Eruptions are unilateral and never
cross the midline of the body. The vesicles
become pustular, breakdown, and form crusts.
Lesions may last for one to two weeks.

11. Clinical Manifestations
2. Pain of varying intensity is a presenting
symptom in about two-thirds of patients. Pain
occurs from one to five days prior to the
development of rash and is neuralgic and
paroxysmal in type. The pain may be described
as burning or stabbing. Patient may complain of
pruritus. The pain is usually worse at night and
is intensified by movement.

12. Clinical Manifestations
3. Fever, malaise, anorexia, and headache occur
for one or more days.
4. Regional lymph nodes are involved in the early
stage of the disease.
5. When the ophthalmic (5th cranial) nerve is
affected, corneal anesthesia may occur, and the
condition is known as Gasserian ganglionitis.
6. Paralysis of the facial nerve and vesicles in the
external auditory canal affects the 7th cranial
nerve. The condition is called Ramsay- Hunt
Syndrome.

13. Diagnostic Exam
1. The characteristic skin rash may be
diagnostic.
2. Tissue culture technique- the virus may
be isolated from fluid taken from newly
developing vesicles.
3. Smear of vesicle fluid
4. Microscopy

14. Complications
1. Encephalitis
2. Paralytic ileus, bladder paralysis
3. Ophthalmic herpes, which may lead to
blindness

15. Modalities of Treatment
1. Symptomatic
2. Antiviral drugs
3. Analgesics to control pain
4. Anti-inflammatory

16. Nursing Management
1. Keep the patient comfortable. Maintain meticulous
hygiene.
2. Keep the patient in strict isolation.
3. Apply cool, wet dressings with NSS to pruritic
lesions.
4. Efforts should be made to prevent secondary
infection.
5. Prevent entrance of microorganism into the lesions,
especially if they are broken.
6. Assess the degree of pain. To avoid neuralgic pain,
do not delay the administration of pain relievers are
prescribed.
7. Encourage sufficient bed rest and provide
supportive care to promote proper healing lesions.
8. Provide the patient with a diversionary activity to
take his mind off the pain and the pruritus.

17. Common Nursing Diagnoses
1. Pain
2. Alteration of comfort
3. Body image disturbance
4. Risk of infection
5. Impaired physical mobility
6. Impaired skin integrity
7. Altered role performance

18. Comparison Between Shingles
and Varicella
Clinical Feature Chickenpox Herpes Zoster
Causative Agent Varicella Virus VZ Virus
Period of
communicability
A day before the
eruption of the 1st
rash up to 5 days
after last crust
Same as in
chickenpox
Evolution of rashes Macule papule
vesicle
pustule
Same as in chicken
pox
Distribution of rashes • Appears first on
the unexposed
part of the body
• Generalized
• Clustered
• Unilateral
• Does not cross the
sagittal portion of
the body

19. Comparison Between Shingles
and Varicella
Clinical Feature Chickenpox Herpes Zoster
Manifestation Itchy • Deep-seated burning
pain that is usually
worst at night
• Lymphadenopathy
• Corneal anesthesia
(Gasserian
Ganglionitis)
• Paralysis of the facial
nerve and the external
auditory canal (
Ramsay- Hunt
Syndrome)
Drug/s of choice • Acyclovir (Zovirax)
• Antipyretic for fever
• Calamine lotion
• Acyclovir
• Analgesics to control
pain
• Anti-inflammatory
Nursing Management • Management is geared
towards the relief of
itchiness
Same as in chickenpox

20. Prevention
 Immunization against chickenpox
 Avoid exposure to a patient suffering from either
varicella or herpes zoster
 Increase the patient’s immune resistance

21. Reference:
 D. Navales. (2010). 3rd edition. Handbook of
common communicable and infectious diseases.
Herpes Zoster. Pg.115